Provider Demographics
NPI:1700121985
Name:CLINICAL DIAGNOSTIC IMAGING LLC
Entity Type:Organization
Organization Name:CLINICAL DIAGNOSTIC IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:
Authorized Official - Last Name:SYPERSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-437-3007
Mailing Address - Street 1:410 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-1635
Mailing Address - Country:US
Mailing Address - Phone:973-661-2000
Mailing Address - Fax:973-661-1116
Practice Address - Street 1:550 KINDERKAMACK RD
Practice Address - Street 2:
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-1500
Practice Address - Country:US
Practice Address - Phone:201-599-8100
Practice Address - Fax:201-599-8480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)